CFlex and autoCPAP; 2 get or not to get w/ 8cm

[dougc4]

I’m a newbie, and am in the market for a CPAP machine, and have been trying to compare and make sense of the different options. (My insurance isn’t covering it, but I don’t mind spending the money on a machine that’s right for me. The way I see it, the more comfortable, the more chance I’ll continue using it, right?) My study showed an AHI of 37 and the doctor has recommended a setting of 8cm.

CFLEX: My doctor says that this option is not necessary for someone using a setting that low (8cm). Does anyone agree/disagree who uses asetting this low?

AutoCPAP: Again, my doctor says that this option is not necessary for someone using a setting that low (8cm). Does anyone agree/disagree who uses a setting this low? So many people on this board have sung such sweet praises of an Auto machine.

(I suppose I could get the REMstar Auto C-Flex CPAP and turn on or of the CFLEX and Auto functions if I don’t find them useful.)

Lastly she recommended a passover (cold) humidifier, and said the heated option was unnecessary to get, unless I develop sinus irritation.

BTW, this message board is great. The Drs. & DMEs just don’t give enough information for someone who really wants to be involved in their treatment. I’d be flying blind without it.

Thanks

Dougc4

[NeurosurgeryNP]

I would definitely go with the heated humidifier. It makes such a hugh difference, not only in comfort, but also compliance.

As for the c-flex - I was set up on a straight cpap with "softx" or another company's equivelant of C Flex. The Rem Star version is much better and I feel it is so comfortable for me. I am only at a 9 - so it's great even for the lower pressures.

As for the auto - I was titrated at 9 - and have my auto set for 8 low and 15 high. I can tell you that I generally stay aroud 9-10 but occasionally go to 11. I notice it more so when I have had a drink or so - they always say you snore worse after drinking. So, it makes sense. I like having the option of auto - but I can always go back to straight cpap and cpap without c flex if I so desire - the RemStar Auto has all of these modes.

I paid myself for the auto - I was set up with a straight cpap through my DME which was a good started machine - but I am so happy I laid out the moneu for the RemStar auto with c flex.

[chrisp]

I don't have C-flex but I here it is a usefull feature . You can always switch it off. I would get a Auto unit . I have the Puitan Bennett GK 420E with the intigrated heated humidifier. The heated humidifier does make a difference. The 420 is the smallest and least expensive auto unit . I also like the Activa mask.

https://www.cpap.com/productpage/1541

Good luck with whatever you choose.

Chris

[Niteair]

As long as you do have a choice in the matter, I would without a doubt get the auto with C-Flex, and definitely with a heated humidifier.......BUY ONCE , BUY the BEST.

[rested gal]

I have the Remstar Auto with C-Flex. I've set my low at 6, and at 7. Cflex on "3" (greatest drop for exhalation) felt very nice even at those lows. I have my range set 8-15 now. C-Flex "3" feels good.

Actually, I don't need C-Flex at all. I can exhale with no problem against pressures up to 14. After that, exhaling gets harder. But there's a noticeable bit of extra comfort (for me) in using C-Flex even down at 6,7, and 8. I'm very much into "comfort".

If a person is going to get an auto and has an opportunity to try several brands out, renting each of the three major brands (Puritan Bennett, Respironics, ResMed) for a month would be a good idea. But if that's out of the question, and a person has only one chance at which one to purchase, any one of the major brands will probably do a fine job for most people.

I usually would recommend the Remstar Auto with C-Flex simply because C-Flex can add a comfort dimension for many. Some don't even like C-Flex, in which case it can be turned off. The other auto I like very, very much is PB's 420E...wish the 420E had something like C-Flex, then it would definitely be my first choice machine.

I think it's important to get the software for whatever auto a person chooses. At least if you're as nosy about your own sleep data as I am.
_____________________________________
My disclaimer: I'm not a doctor, nor have I ever worked in the health care field. Those are just my personal opinions. A mask or machine I love/hate could be completely the opposite for others. Finding suitable equipment can be an expensive trial and error experience.

[WillSucceed]

All of the auto machines have an advantage over the straight CPAP machines in that the auto machines can do single pressure CPAP or variable pressure autopap whereas the straight CPAP machines can ONLY do single pressure.

Within the range of auto machines, it's a question of which features you want AND which machine gives the best treatment. Trying out the different machines is really a wise move if you can swing it.

I did not like C-FLEX at all (gave me stacked breathing) and also found the the algorithm in the RemStar Auto was not best for me. I ended up feeling tired all day after using the RemStar Auto. The ResMed Spirit gave me good treatment as did the PB 420E. I settled on the PB because of size, options and, it's ability to tolerate any mask (except the Comfort Curve).

Trialing the three different machines (RemStar Auto, ResMed Spirit & PB 420E) for a couple of weeks each really helped me to find the one that suited me best.

Good-luck!

[Guest]

My Advice - For What a Guests is worth...

With Respironics C-Flex models (someone help me out with what resmed and pb's 420E do) you can turn the APAP mode on OR if its not working for you, you can turn it off and run your APAP like a strait CPAP.

So you can run in CPAP C-Flex, CPAP, APAP C-Flex, APAP.

Now if you are only ever going to want CPAP, slap down $298 bucks and cpap.com will give you a 420G travel CPAP and you'll be happy. But if you want to cover all your bases, get the Auto and then tweak it until you sleep well.

[maryrose]

definitely go for an auto. I just have a straight machine with the c-flex and I LOVE the c-flex feature. I wish that i had the money for the Auto but i do not. My pressure 15.

[maryrose]

PS: Go with a heated humidifier. The passover is a joke.

[rested gal]

dougc4, your doctor said:

Lastly she recommended a passover (cold) humidifier, and said the heated option was unnecessary to get, unless I develop sinus irritation.

I think maryrose is giving you far better advice than your doctor did, when maryrose said this:

PS: Go with a heated humidifier. The passover is a joke.

As with C-Flex, if it turns out you don't like heated humidification, you can always turn the heat off. Most people do find that a bit of warmer air with a bit of humidification make this kind of treatment easier to use, even if the sinuses aren't an issue.

Given the kind of advice that doctor has come up with for you about several aspects of treatment, I think I'd plan to make all my treatment decisions myself, if I were you. Including getting an autopap and the software for it, so that I wouldn't have to rely on that doctor's judgement that "8" was the pressure I needed. But that's just me, and I'm sure not a doctor.

I wonder sometimes, though, about the amount of "doctorliness" that some people who happen to have an M.D. degree hanging on their wall really have.

[unclebob]

Hi dougc4,

I was also titrated at 8 cm and had the same dilemma you have as to which machine to get. I opted for the Resp auto/C-flex with heated humidifier and the Activa nasal mask. I also bought the card reader and software to monitor what was happening. Nosey little bastard I am and did get my fingers slapped by the sleep MD who considered this to be his holy realm. Apparently I was not supposed to know what was happening and simply bow down to the wizard of wind. And of course let him make the numerous reassessments and adjustments until it was just right. This of course would take many visits and billings. His billings, my visits.

Thought I would try to get out of the loop by taking an active part in monitoring my treatment - thus the choice of equipment. The sleep MD was stunned I would take such a radical course of action. He had no good things to say about any auto titrating device - can you guess why?

By the way; have set my auto at 8 cm low and 16 cm high. I am consistently at 12 cm as the 90 percentile. The pressure levels do vary throughout the night as they are supposed to do in giving me the best and most comfortable treatment. Seems to be working well for me since starting Jan 05.

Long story short - my advice:

- forget straight CPAP, get an auto and tinker all you want.
- WillSucceed's advice to try out equipment is the best advice if you have
the opportunity and the bucks. The major manufacturers all make good
equipment, get the one that works best for you.
- get a heated humidifier.
- the mask is just as important as the machine, check em out then get an
Activa.

Do as much research as possible and make your final decision. After your purchase do not second guess yourself, just live with it. There will always be greener pastures.

Wishing you well.

Bob F

[dougc4]

Great, thoughtful advice everyone! Thank you so much for your responses. I’m definitely leaning toward the REMstar Auto C-Flex CPAP with Heated Humidifier. Now it’s written on the description that

“You should be aware that some interface devices with narrow tubes, such as the Nasal Aire or the Breeze with Nasal Pillows, may have an impact on the ability of this and other auto CPAPs to accurately respond to airflow restrictions during use.”

Have people found this to be true. Should an AutoCPAP user use a more traditional nasal mask like the Activa for the best results?

Doug

[rested gal]

omg, I love this: "the wizard of wind" !!! unclebob, you've coined a classic! ROTFL!

dougc4, despite the warning about interface devices with narrow tubes, all autopaps seem to be able to read most people fine no matter which mask they use. There can always be a few people who are exceptions, but for the majority who post on the message boards, there seems to be no problem using any interface -- even masks with narrow tubes -- mix or match.

I've gotten excellent treatment with the Breeze, Aura, and Swift (all three being narrow tube interfaces) with my REMstar Auto/C-flex.

[WillSucceed]

dougc4 wrote:

“You should be aware that some interface devices with narrow tubes, such as the Nasal Aire or the Breeze with Nasal Pillows, may have an impact on the ability of this and other auto CPAPs to accurately respond to airflow restrictions during use.”

Good point. I noticed this disclaimer as well when I was considering the RemStar Auto. Rested Gal wrote about her success with 'narrow tube' interfaces and I believe she is correct. However, the PB 420E, because of it's seperate sensor tube, works with any mask (except the Comfort Curve).

If you are able to trial the different machines you should be able to find the one that gives you best treatment. If more than one gives you good treatment, you then get to look at features/options/size/etc., to help you make your decision.

All of the auto machines will run in straight CPAP mode so this is a non-factor regarding decision making.

RemStar:
Has C-Flex pressure relief on exhalation -->lots swear by this feature and others hate it. Some users find it triggers 'breath stacking' (rapid shallow breathing that causes awakenings.)
Is a bit of a big machine, not overly portable but not terrible.
Has no options regarding measurement of pulse-oxymetry.
Has no adjustable triggers for tweaking treatment.
Documentation says some masks won't work with this machine.
Software gives data regarding sleep given -->not considered the best analysis software by some users.

ResMed Spirit and/or upgraded L7:
No C-Flex like pressure relief on exhalation.
Allows for attachment of pulse-oxymetry option (very expensive).
No adjustable triggers for tweaking treatment.
Bit of a big clunky machine, not great for travel.
Control panel allows user to tell the unit which interface you are using as long as you are using a ResMed interface. This helps the machine to tailor treatment relative to the interface (leak rate, etc). If you are using a non-ResMed interface, you have to guess.
Analysis software seems on par with Respironics software.

Puritan-Bennett 420E:
No C-Flex like pressure relief on exhalation.
Does not allow attachemnt of pulse-oxymetry options.
Allows adjustment of several triggers for tweaking treatment -->VERY helpful for some users.
Very small, portable machine, even with the integrated heated humidifer, great for travel.
Hose has a seperate sensor line which allows the unit to work with any interface (except Comfort Curve, unless you do a bit of jury-rigging).
Software gives extensive data regarding the treatment given -->considered by some users to be the best software.

[ozij]

All of the auto machines will run in straight CPAP mode so this is a non-factor regarding decision making.

This so important that it should be repeated: You may want to buy an APAP not in order to use it as a APAP, but in order to follow your treatment in detail.

RemStar:
...
Software gives data regarding sleep given -->not considered the best analysis software by some users.

However, Derek's "My Encore" - his software for analysing the basic Respironics Remstar data - makes me, a user of the Sliverlining software green with envy! Derek is a poster in this forum I suggest Doug you look for Derek's posts about the software (use the "search" function on top of page, and make sure to point at the text, no the icon).

And if you decide to run the machine only as CPAP, the software issue becomes even more important.

By the way, I'm another one of those who discovered the Puritan-Bennett 420E is far more congenial to her than the Respironics' Remstar.
And I like the Silverlinig software.


O.